伴毛细血管襻纤维素样坏死IgA肾病的临床病理特点及预后分析  

Clinicopathological Features and Outcomes of IgA Nephropathy with Fibrinoid Necrosis

作　　者：谭敏[1] 张铮[1] 邹古明[1] 李文歌[1] 

机构地区：[1]卫生部中日友好医院肾内科,北京100029

出　　处：《中国中西医结合肾病杂志》2015年第6期499-501,共3页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：国家慢性肾病临床医学研究中心项目(No.2013BAI09B05);北京市自然科学基金资助项目(No.7152127)

摘　　要：目的:回顾性分析伴毛细血管襻纤维素样坏死局灶增生性IgA肾病(IgAN)的临床病理特点及预后,探讨纤维素样坏死在IgAN的意义。方法:对55例伴纤维素样坏死局灶增生性IgAN患者的临床、实验室、病理表现及预后进行回顾性分析;并与同期60例不伴有纤维素样坏死的局灶增生性IgAN进行比较。结果:两组患者临床均可表现为隐匿性肾小球肾炎,肾炎综合征及肾病综合征。坏死组近一半的患者有前驱感染史及血IgA升高,多数患者24 h尿蛋白定量大于1 g,常伴发作性肉眼血尿。病理方面,坏死组伴发局灶新月体形成更常见。随访结束时,两组患者的肾脏生存率在随访期内差异无统计学意义。结论:伴纤维素样坏死的局灶增生性IgAN与对照组比较,尿蛋白大于1 g,前驱感染,发作性肉眼血尿及血IgA升高更常见。可出现肾功能异常。经积极治疗预后与非坏死组比较差异无统计学意义。Objective：To analyze the Clinicopathological features and outcomes of focal proliferative IgAN with fibrinoid necrosis（FN）and discuss the meaning of FN in IgAN. Methods：The clinical,laboratory,pathological manifestations and outcomes of all focal proliferative IgAN patients with FN were retrospectively analyzed and compared. Results：Of all the IgAN cases,IgAN with FN accounted for 6. 3% . Nearly half of these patients is focal proliferative IgAN with FN. Only 3 necrotizing patients showed bad re-nal function. Compared with the control group,prodromal infection、improved serum IgA、proteinuria more than 1. 0 g/ 24 h and gross hematuria were more popular in patients of necrotizing group. The renal survival rate in two groups showed no significant difference in the follow - up period. Conclusion：Prodromal infection、improved serum IgA、proteinuria more than 1. 0 g/ 24 h and gross hematuria were more popular in patients of necrotizing group. After active treatment,there is no difference of the prognosis in two groups.

关 键 词：IGA 肾病 纤维素 坏死 肾脏病理 

分 类 号：R692.31[医药卫生—泌尿科学]